Speaking Out is the fourth title of the filmmaker’s “New Directions” documentary series on women’s empowerment in developing countries. It details the activities of the Center for Care, Activity and Counsel for People Living with HIV (CESAC), in Bamako, Mali. The CESAC is presented as an example of a comprehensive response to HIV/AIDS in a country where the problem is of relatively low proportion for Africa, but still pandemic. Interviews, the primary mode of the video, are extremely well-organized, and focused on three HIV positive women, and a number of professionals who work or consult at the center.

While clearly there are many with HIV who are not being treated, strengths of this community context are evident through the interviews with dedicated and articulate social workers, psychologists, doctors, and other professionals from inside and outside the country. In a place where life expectancy is under 50, individual income averages $600 annually, and the government is largely decentralized, one psychologist explains: the family is the base of the system, the family is rich, but the individual is poor. Another interviewee sketches the reality of what must come before any help is accepted: “the father must understand.” The philosophy of the CESAC is to provide a substitute family structure for those who have been orphaned or abandoned. The support system, which includes European groups, provides a tiny percentage of victims with the $500 needed monthly for drug therapy.

The afflicted here interviewed, recipients of social ostracism and family rejection due to their HIV status, are some of the few who have the courage to speak publicly about their condition. One relates the abuse she suffered after speaking of her condition on a local television show. Along with other activists they work tirelessly on behalf of the infected group in hopes of educating the general public away from misconceptions of the epidemic, and to demonstrate to the Mali government the significance of a pro-active, community based, HIV /AIDS strategy.

The CESAC, established in 1996, provides medical and social support for people living with HIV, with a special focus on women, who are more inclined to respond to the service, and, as caretakers themselves, more in need. For those between 25 and 39, more Malian women than men are infected, and their HIV status jeopardizes not just their own health, but also the health of their children and families. In addition to free medical services, the CESAC provides financial planning, and a strong preventive component addressing the issue of sexuality, a taboo in a Muslim society. The project offers services that benefit not only the HIV or AIDS patient but the entire family, such as food delivery, weekly cooking and nutrition classes, and therapy sessions.

Burke showcases the CESAC project primarily through one of its most vivacious clients, a woman who is also president of the volunteer group, AFAS, The Women’s Association for the Support of Widows and Children of AIDS. She is a substantial, articulate figure, proud of the good health she has maintained and the support she has been able to give to others with HIV. She has married the leader of the men’s support association, who also lost his spouse to AIDS, and they have had a child subsequent to their diagnosis, providing a hopeful model for young people in a culture where raising children is paramount to life itself.

The sound quality of this film is uniformly excellent, and the interviews, while in French and subtitled, are well-conducted and edited, revealing fascinating insights into a relatively homogenous culture coping with demand for extreme change. Striking traditional dresses and local objects emphasize the importance of unique solutions for this kind of community. The candid personal narratives by the three women, which relate the difficult path that began with the pronouncement of their diagnosis – in each case handled sensitively by a social worker – and which allowed them to reconcile the disease with their everyday life, have an unforced blending of sadness and hope. The expression of their desire to move on with lives, in quest of emotional fulfillment including love and marriage, is clearly a tribute to the success of CESAC.

This video, with its focus on small organization, is as an appropriate complement to other titles, such as Race Against Time or The Silent Killer, which present an overview of the governmental, sociological, and economic problems of HIV/AIDS in Africa. Highly recommended for both classrooms and community settings.